How Much Does Breast Reconstruction Cost?

Breast reconstruction typically is performed to re-create one or both breasts after a single or double mastectomy. The American Cancer Society[1] provides a detailed overview of breast reconstruction.

Typical costs:

Without health insurance, breast reconstruction using implants typically costs $5,000 to $15,000 per breast, for a total of $10,000 to $30,000 if both breasts are reconstructed. On RealSelf.com[2] , plastic surgeons discuss estimated total costs for bilateral implant reconstruction without insurance.

Without health insurance, breast reconstruction with "flap" techniques (using tissue from the patient's own body to create new breasts) typically costs $25,000 to $50,000 or more per breast, or $50,000 to $100,000 for both sides. Total costs of $100,000 to $150,000 are not uncommon.

With health insurance, out-of-pocket costs for breast reconstruction total a few hundred to several thousand dollars. In some cases, costs can hit $10,000 to $12,000 or more. Patients on a breast cancer forum[3] discuss out-of-pocket costs for the most expensive surgeries.

When done after a mastectomy, breast reconstruction is covered by health insurance. The federal Women's Health and Cancer Rights Act of 1998[4] requires all U.S. health insurers and self-insured group plans that cover mastectomy to also cover post-mastectomy breast reconstruction, surgery on the other breast to create symmetry and treatment of post-reconstruction complications. Some states also have laws requiring coverage.

In some cases, reconstruction can be done immediately after the mastectomy; in other cases, especially if radiation is being used, the reconstruction is done months, or even years, after the mastectomy.

With an implant, the surgeon usually stretches the skin by inserting a tissue expander under the skin and muscle and, over a four- to six-month period, slowly inflates it by adding saline. When the expansion is complete, the expander is surgically removed and replaced with a silicone gel or saline implant, usually in an outpatient procedure that takes an hour or two under general anesthesia, and requires two to four weeks off work for recovery.

With flap methods, the surgeon removes skin, blood vessels and, with some older techniques, muscle, usually from the abdomen, back or buttocks, and uses that tissue to re-create the breast. These inpatient operations typically use general anesthesia, take four to 12 hours to perform, and require up to a week in the hospital and as long as two months off work. These procedures are complicated and require an experienced surgeon highly skilled in microsurgery. The DIEP Flap[5] procedure is considered by some to be the state-of-the-art technique. Other options include the SIEA Flap[6] , the TUG Flap[7] , the GAP Flap[8] , the TRAM Flap[9] and the Latissimus Dorsi Flap[10] . Which procedure is recommended depends on how much tissue the patient has in a given area, prior surgeries and other health issues. Typically, one or two additional outpatient surgeries (a few hours each) are required, months after the initial operation, for revisions -- smoothing out scars or injecting fat -- and nipple and areola creation. On a breast cancer forum[11] , patients discuss the different stages of surgery.

Additional costs:

An implant will need to be replaced after about 10 or 15 years; insurance typically covers replacement.

Many patients must pay travel and hotel expenses for the initial consultation and at least two to three surgeries.

Getting a nipple and areola tattooed -- usually several months after nipple reconstruction -- by a permanent makeup artist or plastic surgeon typically costs $200 to $600 per breast; some providers offer the service free to breast cancer survivors.

Discounts:

The nonprofit My Hope Chest[12] helps qualifying women pay for breast reconstruction. And the United Breast Cancer Foundation[13] offers financial help for patients in need.

Shopping for breast reconstruction:

A plastic surgeon performs breast reconstruction. Make sure the doctor is certified by the American Board of Plastic Surgery and has privileges at an accredited hospital, even if the surgery is not taking place there. The American Society of Plastic Surgeons[14] and the American Society for Aesthetic Plastic Surgery[15] offer referrals. Ask about the surgeon's experience and success rate, and ask to see before-and-after photos of previous patients. According to this guide on how to find a surgeon, from Plastic Reconstructive & Microsurgical Associates[16] , a surgeon should have performed at least 100 procedures and, in the case of flap procedures, should have a success rate (where the flap of tissue lives in its new location) of at least 97 percent.

Possible risks include bleeding, swelling, infection, pain, scarring, necrosis of tissue (cell death) requiring more surgery, change in or loss of sensation, and reaction to anesthesia that could include death. Ask about specific risks for each type of procedure (such as an abdominal hernia or lifelong limits on lifting weight after the TRAM Flap procedure). BreastReconstruction.org[17] provides surgeon-reviewed information and discussion forums for patients, and BreastCancer.org[18] has a reconstruction discussion forum.

Material on this page is for informational purposes only and should not be construed as medical advice. Always consult your physician or pharmacist regarding medications or medical procedures.

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